'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

One in three benzodiazepine prescriptions last over a year, GPs warned

A quarter of a million patients may be prescribed benzodiazepines and Z-drugs for over 12 months by GPs, despite guidance that states they must be prescribed for no longer than four weeks, shows a new study.

The study, published in the BJGP, suggests that just under 300,000 patients nationwide are taking benzodiazepines or Z-drugs for longer than recommended.

The BNF recommends that benzodiazepines should be prescribed in short courses only and for no longer than four weeks, due to the high risk of dependency, potential adverse neurological and cognitive outcomes and difficulty in withdrawing.

But a research team from the University of Roehampton looked at data from just under 100,000 benzodiazepine and Z-drug users in GP practices and found 35% were taking benzodiazepines and Z-drugs for at least 12 times longer than the BNF recommends.

The RCGP said that there were currently not enough specialist addiction-management services, and this was behind the problem.

The data were collected by the Bridge Project, a prescribed drug withdrawal support charity and they showed 0.69% of patients had been prescribed benzodiazepines and Z-drugs for more than a year.

The research paper said: ‘The results also suggest that 35% of all users of [benzodiazepines and Z-drugs] are taking these drugs long term — that is, for at least 12 times longer than the BNF recommends.’

The team also found that 43% of patients in the study group were interested in being supported to come off the drugs, suggesting that just over 119,000 patients in the UK may also be interested in making use of withdrawal services.

They said: ‘The first recommendation is to reduce prescribing levels by ensuring adherence to existing guidelines for prescribing and withdrawal, and develop new guidelines where needed.

'Many of the patients experiencing problems with prescribed medicines may have avoided the associated harms if existing prescribing guidelines had been followed.’

They also recommended that GPs should be more active in identifying long-term users and helping them to withdraw safely .

RCGP chair Professor Helen Stokes-Lampard said: 'Benzodiazepines and other psychotropic drugs can be very effective when they are prescribed appropriately and in accordance with clinical guidelines, something that GPs are highly trained to do, taking into account the unique physical, psychological and social factors potentially affecting the health of the patient in front of us, and in conversation with them.

'But they can also be very addictive – and withdrawal from benzodiazepines requires careful management by healthcare professionals, so it’s vital that there are sufficient addiction-management services available in the community to facilitate this, and at present this unfortunately is not the case.

'Some patients taking these drugs will be particularly vulnerable and will require additional specialist services.'

She added that the RCGP 'would strongly support' the researchers' call for patients dependent on prescription drugs to 'have easy, consistent, but also confidential access to support', as well as 'more guidance' for healthcare professionals to 'appropriately manage prescriptions'.

Personally fed up registering new patients, to find that out they are addicted to benzos, z-drugs or opiates thanks to some irresponsible prescribing elsewhere, and that it is now my problem to manage.

An interesting statistic. How many of these meds were initiated in secondary care with no instructions on long term usage and the assumption that the good ol' Gp will stop them when deemed appropriate?

Patients WANT to take benzos. review any addicts set of notes and you will see all the "seven days only" note at the start Persistent attendances and requests eventually get put on repeat and voila! Most GPs are too kind!Or you could have a sector psychiatrist who will give them whatever they want at whatever dose they like and then discharge them for a fight!

The problem is what happens when you try and wean/stop them. The patients inevitably complain and then drag you through the multiple jeopardy system. On an individual GP basis its just not worth the risk of this. We need new legislation to support us.

Agree with meerkat. Ban or unlicense these drugs, with 6 months notice. Then let us blame "those upstairs" while cheerfully stopping this drugs.Same thing has been helpful for gluten free foods. "not allowed to issue", job done.I remember the threat of GPs being struck off for giving antibiotics. Lots of news headlines, helped patients understand that abx are not advised for most illness. (unless you have COPD, where apparently you can fill your boots).We need to properly restrict these harmful medicines.

I am not sure they are useful at all. They help with our "need to do something" but they just delay the necessary psychological processes needed to digest bad news etc. For me they should be banned altogether.

what do you do after 4 weeks . I have not seen many successes from addiction team. when you inherit a patient who is taking them before for 20 years, he/she has answer to all questions . they will not leave surgery unless you are willing to argue with them for long time. you can't stop drugs suddenly so give smaller quantities and story continue for next consultation with another doctor.
take license away to prescribe these like we did with diconal.